Neighborhood social organization exposures and racial/ethnic disparities in hypertension risk in Los Angeles

Abstract

Despite a growing evidence base documenting associations between neighborhood characteristics and the risk of developing high blood pressure, little work has established the role played by neighborhood social organization exposures in racial/ethnic disparities in hypertension risk. There is also ambiguity around prior estimates of neighborhood effects on hypertension prevalence, given the lack of attention paid to individuals’ exposures to both residential and nonresidential spaces. This study contributes to the neighborhoods and hypertension literature by using novel longitudinal data from the Los Angeles Family and Neighborhood Survey to construct exposure-weighted measures of neighborhood social organization characteristics—organizational participation and collective efficacy—and examine their associations with hypertension risk, as well as their relative contributions to racial/ethnic differences in hypertension. We also assess whether the hypertension effects of neighborhood social organization vary across our sample of Black, Latino, and White adults. Results from random effects logistic regression models indicate that adults living in neighborhoods where people are highly active in informal and formal organizations have a lower probability of being hypertensive. This protective effect of exposure to neighborhood organizational participation is also significantly stronger for Black adults than Latino and White adults, such that, at high levels of neighborhood organizational participation, the observed Black-White and Black-Latino hypertension differences are substantially reduced to nonsignificance. Nonlinear decomposition results also indicate that almost one-fifth of the Black-White hypertension gap can be explained by differential exposures to neighborhood social organization.

Impact of Social Determinants of Health on Hypertension Outcomes: A Systematic Review

“…14,21–24,28,29,31,33,34,36,37,40–42,45,46,51,58–60,63,65,67–70,74,76 using a variety of measures, including income-to-poverty ratio, 21,40,45 family income-to-poverty ratio, 28 employment status, 14,28,33,37,42,60,63 employment categories, 23 poverty status, 29,70 federal poverty line, 31,41 cost-related medication nonadherence, 34 financial strain, 14,59 individual income level, 14,36,46,63,68,69,76 household income, 22,65,67,74 house tenure, 14 state-level minimum wage, 24 total wealth, 14,36 and net worth. 68 Neighborhood environment was examined in 58% (n=33) of the studies 14,22,26,27,30,32,35,38,41–44,46,49–53,55–57,59–64,66,70–74 as a primary contributor using several variables including neighborhood problems, 14 safety, 14 crime, 50,52 walkability 22,43,51,52,55,62,70,73 and SES, 22,43,51,52,…”

“…68 Neighborhood environment was examined in 58% (n=33) of the studies 14,22,26,27,30,32,35,38,41–44,46,49–53,55–57,59–64,66,70–74 as a primary contributor using several variables including neighborhood problems, 14 safety, 14 crime, 50,52 walkability 22,43,51,52,55,62,70,73 and SES, 22,43,51,52,55,62,70,73 area mortgage foreclosures, 26 homeownership, 26 social deprivation index, 41,46,70 rurality of residence, 41,46,70 zip code credit score, 30 particulate matter air pollution, 32 urban rural census code, 53 housing security, 53 built environment, 57,60 neighborhood social organization 64 and residential mobility, 42,61 food security, 56,71,72 and segregation. 35,70 Social and community context were explored in 25% (N=14) of the studies 14,22,25,28,29,35,39,46,48,54,58,59,63,64 as a primary contributor with marital status, 14,21,28,29,37,42,50,52,60,62,66,76 psychological distress,…”

“…Hypertension prevalence 14,22,23,26,28,29,36,40,41,45,46,48,49,52,55,56,59,60,63,66,67,69,70,73–76 was the most frequently examined outcome, featured in 47% of the studies. Hypertension incidence 27,32,35,36,39,42,44,47,51,61 was reported in 18% of the studies, while hypertension control 28,31,33,34,38,65 and hypertension diagnosis 24,30,37,53,57,58,64,75 were examined in 11% and 14% of the studies, respectively. Mean SBP and DBP 21,25,40,50,54,59,62,68,71–73,75 were considered in 22% of the studies, and the effect on SBP and DBP 27,43,61,68 was assessed in 7% of the studies.…”

“…68 Neighborhood environment was examined in 58% (n=33) of the studies 14,22,26,27,30,32,35,38,[41][42][43][44]46,[49][50][51][52][53][55][56][57][59][60][61][62][63][64]66,[70][71][72][73][74] as a primary contributor using several variables including neighborhood problems, 14 safety, 14 crime, 50,52 walkability 22,43,51,52,55,62,70,73 and SES, 22,43,51,52,55,62,…”

“…Overall, as neighborhood characteristics declined, BP worsened in most of the studies. 26,27,35,44,49,50,57,61,62,64,66 For example, Chambers et al 26 found a 25% higher prevalence of hypertension among renters residing in high foreclosure risk areas (compared with low foreclosure risk areas). Similarly, 2 studies 27,74 found higher BP among adults residing in more deprived neighborhoods (compared with the least deprived).…”